Occlusion

Concepts of Occlusion

Occlusion is defined as the static relationship of teeth Articulation is defined as the dynamic relationship of teeth Tooth alignment and occlusion is important in masticatory function Tooth positioning is not a random process A number of controlling factors are involved

Esthetic smile BMC 59.1

Concepts of Occlusion
Balanced Occlusion

Bilateral and balancing contacts through all excursive movements

Protrusive Laterotrusive

Developed for complete dentures Rationale was thought to provide stability to dentures through all excursive movements

Esthetic smile BMC 59.1

Concepts of Occlusion
Optimal Occlusion Dynamic Individual Occlusion Concept is based on function and health rather than any ideal occlusal arrangement In the absence of pathology, no treatment to change a patients occlusion would be necessary Developed in the late 1970s

Esthetic smile BMC 59.1

Classification of Occlusion
Morphological classification
malocclusion normal occlusion individual normal occlusion; ideal normal occlusion

Functional classification
physiological occlusion pathological occlusion

Clinical classification adaptable occlusion

unadaptable occlusion

Tooth Alignment and Occlusion

Factors determining tooth position Normal intra-arch relationships Normal interarch relationships
Sagittal view of human skull BMC 62.6

Tooth Alignment and Occlusion

Factors determining tooth position

Forces from many directions act to position the tooth in a position of equilibrium

Lips Cheeks Tongue

Forces are light and constant Have the ability to move teeth over time Tooth stability is achieved in the neutral position
Anterior (top) and posterior (bottom) teeth in neutral position Okeson Fig. 3-1

Tooth Alignment and Occlusion

Factors determining tooth position

When a tooth erupts out of alignment, forces from the tongue and lip can move the tooth to the neutral position Must be adequate space for the tooth If there is crowding, the muscular forces are insufficient to produce the necessary movement Orthodontic treatment would then be required
Anterior (top) and posterior (bottom) teeth in neutral position Okeson Fig. 3-1

Tooth Alignment and Occlusion

Factors determining tooth position

Erupted teeth will be moved until an equilibrium is established Large tongue Tongue thrust Oral habits

Thumb sucking Finger sucking Pencil sucking Chewing on a pipe Musical instruments

Anterior open bite due to a large tongue (tongue at rest) Okeson Fig. 3-2a

Tooth Alignment and Occlusion

Factors determining tooth position

Erupted teeth will be moved until an equilibrium is established Tongue thrust An anterior open bite has resulted from excessive labially directed forces from the tongue

Very active tongue producing an open bite Okeson Fig. 3-2c

Tooth Alignment and Occlusion

Factors determining tooth position

Forces on proximal tooth surfaces

Contacts with adjacent teeth maintain normal alignment There is a normal mesial migration of teeth towards the midline Normal function produces proximal surface wear Mesial migration tends to maintain contacts
Consequences of loss of a single molar Okeson Fig. 3-2d

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Plane of occlusion (PO)

A line through the mandibular incisal ridges and the DB cusps of the second molars Actually a planar mean of the curvature of the surfaces Not flat Generated by a line drawn through all buccal cusp tips and incisal ridges connecting the lingual cusps and producing a plane Curved plane to allow multiple areas of contact during mandibular movement A result of inclination of teeth within the arches

Orientation lines and planes AE angle of eminentia FH Frankfort horizontal CS Curve of Spee PO Plane of occlusion IG Incisal guidance Ash Fig. 2-16

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Plane of occlusion (PO)

A line through the mandibular incisal ridges and the DB cusps of the second molars Actually a planar mean of the curvature of the surfaces Not flat Generated by a line drawn through all buccal cusp tips and incisal ridges connecting the lingual cusps and producing a plane Curved plane to allow multiple areas of contact during mandibular movement A result of inclination of teeth within the arches

Sagittal view of the angulation of mandibular teeth Okeson Fig. 3-5

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Plane of occlusion (PO)

A line through the mandibular incisal ridges and the DB cusps of the second molars Actually a planar mean of the curvature of the surfaces Not flat Generated by a line drawn through all buccal cusp tips and incisal ridges connecting the lingual cusps and producing a plane Curved plane to allow multiple areas of contact during mandibular movement A result of inclination of teeth within the arches

Sagittal view of the angulation of maxillary teeth Okeson Fig. 3-6

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Plane of occlusion (PO)

A line through the mandibular incisal ridges and the DB cusps of the second molars Actually a planar mean of the curvature of the surfaces Not flat Generated by a line drawn through all buccal cusp tips and incisal ridges connecting the lingual cusps and producing a plane Curved plane to allow multiple areas of contact during mandibular movement A result of inclination of teeth within the arches

Frontal view of the angulation of maxillary teeth Okeson Fig. 3-7

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Plane of occlusion (PO)

A line through the mandibular incisal ridges and the DB cusps of the second molars Actually a planar mean of the curvature of the surfaces Not flat Generated by a line drawn through all buccal cusp tips and incisal ridges connecting the lingual cusps and producing a plane Curved plane to allow multiple areas of contact during mandibular movement A result of inclination of teeth within the arches

Frontal view of the angulation of mandibular teeth Okeson Fig. 3-8

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Curve of Spee

Anteroposterior curvature of the arch Formed by a line joining the mandibular incisal ridges to the buccal cusps of the mandibular posterior teeth

Curve of Spee- the anteroposterior curvature of the arch Mohl Fig. 4-4

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Curve of Wilson

Mediolateral curvature of the arch Formed by drawing a line through the buccal and lingual cusps of the molars Usually concave in an unworn dentition Can be convex when the dentition is worn (resulting in shorter buccal cusps of the mandibular molars; called a reverse Curve of Wilson.

Curve of Wilson- the mediolateral curvature of the arch (posterior view Mohl Fig. 4-5a

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Curve of Wilson

Mediolateral curvature of the arch Formed by drawing a line through the buccal and lingual cusps of the molars Usually concave in an unworn dentition Can be convex when the dentition is worn (resulting in shorter buccal cusps of the mandibular molars

Curve of Wilson- the mediolateral curvature of the arch (posterior view Mohl Fig. 4-5b

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Standardized formulae were sought to describe intra-arch relationships Bonwill, WGA 1889

Described a 4 inch equilateral triangle from condylar centres to mesial of the mandibular incisors Described a sphere (Sphere of Monson) with a radius of 4 inches that was equidistant from the condylar centres and the occlusal surfaces of the posterior teeth

Monson, GS 1932

Both are oversimplifications and generalizations that apply to some people but not all Represent a geometrical ideal

Bonwills triangle and Monsons sphere Mohl Fig. 12-3

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Occlusal surfaces of the teeth

Cusps Cusp ridges Grooves Sulci Function in breaking up food into smaller pieces

Occlusal table

50-60% of the total buccolingual dimension of the tooth Masticatory forces are applied to this area Positioned within the confines of the root

Occlusal table (top) Okeson Fig. 3-9 Outer and inner inclines of the crown (bottom) Okeson Fig. 310

Tooth Alignment and Occlusion

Normal Intra-arch Relationships

Occlusal surfaces of the teeth

Cusps Cusp ridges Grooves Sulci Function in breaking up food into smaller pieces

Occlusal table

50-60% of the total buccolingual dimension of the tooth Masticatory forces are applied to this area Positioned within the confines of the root

Mesial and distal inclines of teeth Okeson Fig. 3-11

Tooth Alignment and Occlusion

Normal Interarch Relationships

An interarch relationship relates the teeth in one arch to the teeth in the other arch As the mandible closes, the occlusal relationship of the teeth is determined Arch length Distance from the distal surface of one third molar to the other in the same arch 128mm Max arch 126mm Mand arch Arch width Distance across the arch Mandibular width is slightly less than maxillary width

Normal buccolingual relationship of the molars Okeson Fig. 3-12

Tooth Alignment and Occlusion

Normal Interarch Relationships

Normal buccolingual relationship allows for

efficient use of musculature in chewing Minimizing trauma from cheek or tonguebiting

Supporting cusps
buccal cusps of Mandibular posterior teeth lingual cusps of Maxillary posterior teeth Centric cusps Centric holding cusps Stamp cusps Maintain vertical dimension or distance between the maxilla and mandible

Normal buccolingual relationship of the molars Modified after Okeson Fig. 312

Tooth Alignment and Occlusion

Normal Interarch Relationships

Centric holding cusps are important in mastication Contact occurs on outer and inner inclines of the cusp Centric holding cusp position is approximately 1/3 into the total buccolingual dimension

What is the significance of the position of the centric cusps in this buccolingual direction?
Forces are directed over the long axis of the tooth and are dissipated through the root.

Centric holding cusp position (mandibular first molar) BLUE centric cusps YELLOW non-centric cusps Okeson Fig. 3-14

Tooth Alignment and Occlusion

Normal Interarch Relationships

Guiding cusps
lingual cusps of Mandibular posterior teeth buccal cusps of Maxillary posterior teeth Non-centric cusps Non-centric holding cusps Shear cusps Non-centric holding cusp position is approximately 1/6 into the total buccolingual dimension Cusps tend to be sharper with defined cusp ridges and tips

Normal buccolingual relationship of the molars Modified after Okeson Fig. 312

Tooth Alignment and Occlusion

Normal Interarch Relationships
FUNCTIONAL OUTER ASPECT
Outer aspect of centric cusp contacts about 1mm

Functional Outer Aspect Modified after Okeson Fig. 315

Tooth Alignment and Occlusion

Normal Interarch Relationships
Identify the centric holding cusps when there is a posterior crossbite relationship.

LINGUAL CUSPS of Mandibular posterior teeth BUCCAL CUSPS of Maxillary posterior teeth

Crossbite relationship of the molars Okeson Fig. 3-13

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Buccolingual A line drawn through the buccal cusps of mandibular teeth illustrates the Bucco-occlusal line Line follows arch form and is smooth and continuous Line divides the outer and inner aspects of the mandibular centric cusps

Mandibular bucco-occlusal line Okeson Fig. 3-16

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Buccolingual A line drawn through the lingual cusps of maxillary teeth illustrates the Linguo-occlusal line Line follows arch form and is smooth and continuous Line divides the outer and inner aspects of the mandibular centric cusps

Maxillary bucco-occlusal line Okeson Fig. 3-17

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Buccolingual A continuous line drawn through the central developmental grooves of maxillary and mandibular posterior teeth illustrates the Central fossa (CF) line Line follows arch form and is smooth and continuous

Central fossa line Okeson Fig. 3-18

Tooth Alignment and Occlusion

Normal Interarch Relationships

The contacts are usually slightly buccal to the central fossa line.

Central fossa line, contacts and embrasures Modified after Okeson Fig. 3-18

Tooth Alignment and Occlusion

Normal Interarch Relationships

The buccal embrasure is smaller and shaped like a wide V. The lingual embrasure area is larger and is shaped like a long narrow V.

Central fossa line, contacts and embrasures Modified after Okeson Fig. 3-18

Tooth Alignment and Occlusion

Normal Interarch Relationships
What is the clinical significance of the contact position and embrasure shape? The lingual embrasure acts as a spillway. Food is directed towards the tongue during mastication. The tongue then directs the food back towards the occlusal table. This is more efficient than having the perioral and buccinator muscles direct food towards the occlusal table in the other direction.

Central fossa line, contacts and embrasures Modified after Okeson Fig. 3-18

Tooth Alignment and Occlusion

Normal Interarch Relationships

In a normal occlusion, the MANDIBULAR BUCCAL CUSPS (CHC) will occlude in the central fossa and on marginal ridges of the maxillary posterior teeth.

Central fossa line and buccoocclusal line Okeson Fig. 320

Tooth Alignment and Occlusion

Normal Interarch Relationships

In a normal occlusion, the MAXILLARY LINGUAL CUSPS (CHC) will occlude in the central fossa and on marginal ridges of the mandibular posterior teeth.

Central fossa line and buccoocclusal line Okeson Fig. 320

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Mesiodistal

Occlusal contacts result from centric cusps contacting the opposing CF line Contacts will occur in or on

Central fossae
AND

Marginal ridges and embrasures

Normal contacts in a Class I occlusion Okeson Fig. 3-23

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Mesiodistal Occlusal contacts result from centric cusps contacting the opposing CF line Contacts will occur in Central fossae

Comparable to a mortar and pestle Two dissimilar shaped surfaces meet result in a spillway being produced and masticatory efficiency

SUMMARY STATEMENTS

Mesiolingual cusp of each maxillary molar occludes in the central fossa of the opposing mandibular molar Mesiobuccal cusp of each mandibular molar occludes on the mesial marginal ridge of the opposing maxillary molar

Normal contacts in a Class I occlusion Modified after Okeson Fig. 3-23

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Mesiodistal Occlusal contacts result from centric cusps contacting the opposing CF line Contacts will occur in Central fossae

Comparable to a mortar and pestle Two dissimilar shaped surfaces meet result in a spillway being produced and masticatory efficiency

Marginal ridges and embrasures

Cusp tip is very convex Marginal ridge is slightly convex (flat by comparison) Actual contact is not cusp tip but 0.5mm area around it

Normal contacts in a Class I occlusion Modified after Okeson Fig. 3-23

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Mesiodistal Occlusal contacts result from centric cusps contacting the opposing CF line Contacts will occur in Central fossae

Comparable to a mortar and pestle Two dissimilar shaped surfaces meet result in a spillway being produced and masticatory efficiency

Marginal ridges and embrasures

Cusp tip is very convex Marginal ridge is slightly convex (flat by comparison) Actual contact is not cusp tip but 0.5mm area around it
Cusp tip to two marginal ridges (embrasure) contact Okeson Fig. 3-22

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Mesiodistal Occlusal contacts result from centric cusps contacting the opposing CF line Contacts will occur in Central fossae

Comparable to a mortar and pestle Two dissimilar shaped surfaces meet result in a spillway being produced and masticatory efficiency

Marginal ridges and embrasures

Cusp tip is very convex Marginal ridge is slightly convex (flat by comparison) Actual contact is not cusp tip but 0.5mm area around it
Cusp tip to marginal ridge contact Modified after Okeson Fig. 3-22

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Mesiodistal

Each tooth contact two teeth in a normal Class I occlusion with two exceptions
Which teeth only occlude with one opposing tooth? Mandibular central incisors contact only the maxillary central incisor Maxillary third molars contact only the mandibular third molars

The one tooth to two teeth contact relationship assists in force distribution

Cusp tip to marginal ridge contact Modified after Okeson Fig. 3-22

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Occlusal contacts of posterior teeth The mandibular first molar is positioned mesial to the maxillary first molar The mesiobuccal cusp of the mandibular first molar occludes in the embrasure between the maxillary second premolar and the first molar The mesiobuccal cusp of the maxillary first molar is opposite the mesiobuccal (buccal) groove of the mandibular first molar The mesiolingual cusp of the maxillary first molar occludes in the central fossa of the mandibular first molar
Interarch relationship of opposing teeth Modified after Okeson Fig. 3-21

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Occlusal contacts of posterior teeth The mandibular first molar is positioned mesial to the maxillary first molar The mesiobuccal cusp of the mandibular first molar occludes in the embrasure between the maxillary second premolar and the first molar The mesiobuccal cusp of the maxillary first molar is opposite the mesiobuccal (buccal) groove of the mandibular first molar The mesiolingual cusp of the maxillary first molar occludes in the central fossa of the mandibular first molar
Class I molar relationship (facial view) BMC 62.11a

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Occlusal contacts of anterior teeth

Maxillary anterior teeth are normally positioned vertically and horizontally overlapping the mandibular anterior teeth Maxillary anterior teeth have a labial inclination of 12-28 degrees Incisal edges of mandibular incisors usually contact maxillary incisors 4mm from incisal edge Little more than half of the crown of the mandibular incisors will show (9mm crown length)

5mm

9mm

Vertical overlap of anterior teeth Okeson Fig. 3-26

Tooth Alignment and Occlusion

Normal Interarch Relationships
Contact Relationships- Occlusal contacts of anterior teeth

Maxillary anterior teeth are normally positioned vertically and horizontally overlapping the mandibular anterior teeth Maxillary anterior teeth have a labial inclination of 12-28 degrees Incisal edges of mandibular incisors usually contact maxillary incisors 4mm from incisal edge Little more than half of the crown of the mandibular incisors will show (9mm crown length) Horizontal overlap is termed OVERJET Vertical overlap is termed OVERBITE
Vertical and horizontal overlap of anterior teeth Okeson Fig. 3-27

Tooth Alignment and Occlusion

Normal Interarch Relationships

Tooth Alignment and Occlusion

Normal Interarch Relationships

Tooth Alignment and Occlusion

Contacts during Mandibular Movements
Contact Relationships- Dynamic Movements

Complex mandibular movements are possible in three planes

Sagittal Horizontal Frontal

Mandibular movements result in possible tooth contacts

Desirable Undesirable Protrusive Retrusive Laterotrusive

Basic mandibular movements

Anterior guidance Okeson Fig. 3-29

Tooth Alignment and Occlusion

Contacts during Mandibular Movements
Contact Relationships- PROTRUSION

Mandible moves forward from maximum intercuspation (MI) or intercuspal position (ICP) In a normal protrusive movement in a dentate patient only the anterior teeth are in contact Guiding inclines (GI) of the anterior teeth are

Maxillary lingual fossae and incisal edges Mandibular labial and incisal edges Influence of contacting surfaces of anterior teeth on tooth limiting mandibular movements
Anterior guidance Okeson Fig. 3-29

Anterior Guidance

Tooth Alignment and Occlusion

Contacts during Mandibular Movements
Contact Relationships- PROTRUSION

Potential posterior contacts in a protrusive movement are the

mesial inclines of mandibular teeth (fossae and marginal ridges) distal inclines of the maxillary teeth (lingual cusps)

These contacts are undesirable and are called Protrusive interferences

Anterior guidance Okeson Fig. 3-30

Tooth Alignment and Occlusion

Contacts during Mandibular Movements
Contact RelationshipsLATEROTRUSIVE MANDIBULAR MOVEMENT Desirable contacts in a left laterotrusive movement are maxillary buccal cusps in contact with mandibular buccal cusps
Nonworking Side Working Side

Left laterotrusive movement (and right mediotrusive movement) Okeson Fig. 3-31

Tooth Alignment and Occlusion

Contacts during Mandibular Movements
Contact RelationshipsLATEROTRUSIVE MANDIBULAR MOVEMENT

Other contacts that may occur include WORKING SIDE (LATEROTRUSIVE) INTERFERENCES

Nonworking Side

Working Side

Outer inclines of maxillary lingual cusps Inner inclines of mandibular lingual cusps

NON-WORKING (MEDIOTRUSIVE) INTERFERENCES

Left laterotrusive movement (and right mediotrusive movement) Okeson Fig. 3-31

Inner inclines of maxillary lingual cusps Inner inclines of mandibular buccal cusps

Tooth Alignment and Occlusion

Contacts during Mandibular Movements
Contact Relationships- RETRUSIVE MANDIBULAR MOVEMENT

Occurs when the mandible moves from MI in a posterior direction Movement of 1-2mm can occur Movement is restricted by ligaments Contacts can occur on the

Mesial inclines of the fossae and marginal ridges of maxillary teeth with the distal inclines of the cusps of mandibular teeth Mesial inclines of the cusps of the maxillary teeth with the distal inclines of the fossae and marginal ridges of mandibular teeth

Retrusive mandibular movement Okeson Fig. 3-32

Tooth Alignment and Occlusion

Contacts during Mandibular Movements
Contact Relationships- POTENTIAL AREAS OF CONTACTS DURING ECCENTRIC MANDIBULAR MOVEMENTS Posterior teeth

Possible contacts during eccentric mandibular movements Okeson Fig. 3-33

Optimal Tooth Contacts

Occlusal contacts influence the muscular control of the position of the mandible Occlusal contacts result in neuromuscular feedback to find a stable occlusal position Muscles can generate forces much greater than are required for function Occlusal relationships should be developed to minimize possibility of damage to

CNS

Mus.

Teeth Peridontium Muscles TM joints

Occ.

TMJ

Optimal Tooth Contacts

Summary

Contact with all teeth should be of even magnitude and simultaneous Forces on individual teeth are minimized with this arrangement Condyles should be in their most anterosuperior position in the fossa (MS position or CR position) Therefore ideally, ICP is coincident with CR (MS) This is called orthopedic stability

Muscle activity and mandibular movement with bilateral molar and premolar contacts Okeson Fig. 5-8

Optimal Force Direction

Bone reacts to pressure force by resorbing Periodontal ligament suspends the tooth in its socket Most PDL fibres run in an oblique direction Pressure force is converted to a tension force and stimulates bone formation PDL can be considered to be a shock absorber that protects bone from occlusal force

Expanded view of periodontal ligament Okeson Fig. 5-9

Optimal Force Direction

Occlusal forces directed along a cusp tip or flat surface such as a fossa or marginal ridge directs the force through the long axis of the tooth Vertically directed forces are called axial loading

Expanded view of periodontal ligament Okeson Fig. 5-9

Optimal Force Direction

Occlusal forces directed along a cusp tip or flat surface such as a fossa or marginal ridge directs the force through the long axis of the tooth Vertically directed forces are called axial loading

Axially directed forces Okeson Fig. 5-10

Optimal Force Direction

Axial loading can be achieved in two ways Develop contacts on cusp tips or flat surfaces (fossa or marginal ridges)

Develop three contacts surrounding a cusp tip as it contacts a fossa

Called tripodization
Axially directed forces Okeson Fig. 5-12a and b

Optimal Force Direction

Both direct forces axially and eliminate non-axially directed forces Non-axially directed forces produce tipping forces that result in
A compression of the PDL B expansion of the PDL

Potential for bone resorbtion

Non-axially directed forces Okeson Fig. 5-11

Optimal Force Magnitude

Mandibular movements include laterotrusive and protrusive movements Allows horizontal forces to be placed on teeth

Forces are potentially damaging

Are some teeth better than others to accept these horizontal forces? Masticatory system is a lever system Similar to a nutcracker More force can be generated closer to the fulcrum

Greater force magnitude can be produced closer to the fulcrum (TMJ) Okeson Fig. 5-13

Optimal Force Magnitude

Mandibular movements include laterotrusive and protrusive movements Allows horizontal forces to be placed on teeth

Forces are potentially damaging

Are some teeth better than others to accept these horizontal forces? Masticatory system is a lever system Similar to a nutcracker More force can be generated closer to the fulcrum

Greater force magnitude can be produced closer to the fulcrum (TMJ) Okeson Fig. 5-13

Optimal Force Magnitude

More force can be generated on posterior teeth than on anterior teeth Damaging horizontal forces are best managed by the anterior teeth Which of the anterior teeth are best suited to accept horizontal forces in eccentric movements?

Central incisors Lateral incisors Canines

Why?

Greater force magnitude can be produced closer to the fulcrum (TMJ) Okeson Fig. 5-13

Optimal Force Magnitude

Which of the anterior teeth are best suited to accept horizontal forces in eccentric movements?

Canines Longest and largest roots Best crown:root ratio Surrounded by dense compact bone compared to the medullary bone of posterior teeth Due to sensory input, there is lower muscle activity when the canines are in contact

Why?

Therefore, the canines are the best teeth to be in contact during a laterotrusive movement Arrangement is called canine guidance or canine rise occlusion

Left laterotrusive movement illustrating canine guidance Okeson Fig. 5-14

Optimal Force Magnitude

Which of the anterior teeth are best suited to accept horizontal forces in eccentric movements?

Canines Longest and largest roots Best crown:root ratio Surrounded by dense compact bone compared to the medullary bone of posterior teeth Due to sensory input, there is lower muscle activity when the canines are in contact

Why?

Therefore, the canines are the best teeth to be in contact during a laterotrusive movement Arrangement is called canine guidance or canine rise occlusion

Lingual view of a right laterotrusive movement with canine guidance Okeson Fig. 5-14

Optimal Force Magnitude

Most patients have other teeth in addition to the canines in contact in a laterotrusive movement If canines plus some other posterior teeth are in contact in a laterotrusive movement, it is called a group function occlusion Best arrangement is canines, premolars and the MB cusp of the first molar Additional posterior contacts are undesirable due to proximity to the fulcrum (TM joint)
Left laterotrusive movement illustrating group function Okeson Fig. 5-15

Optimal Force Magnitude

Most patients have other teeth in addition to the canines in contact in a laterotrusive movement If canines plus some other posterior teeth are in contact in a laterotrusive movement, it is called a group function occlusion Best arrangement is canines, premolars and the MB cusp of the first molar Additional posterior contacts are undesirable due to proximity to the fulcrum (TM joint)
Lingual view of a right laterotrusive movement with group function Okeson Fig. 5-15

Optimal Force Magnitude

Protrusive movements can generate horizontal forces that are potentially damaging Anterior teeth are best suited to dissipate these forces

Distance from the fulcrum

Anterior teeth should disclude the posterior teeth because of the

Amount of force on posteriors Direction of force on posteriors

Lingual view of a protrusive movement Okeson Fig. 5-17

In a protrusive movement, only the anterior teeth should contact, not the posterior teeth

Optimal Force Magnitude

Summary

Anterior teeth cannot tolerate heavy forces on closure (due to axial inclination) Posterior teeth are best able to withstand closing forces Anterior teeth are best able to tolerate eccentric forces

Laterotrusive Protrusive
Vestibular view of posterior bite collapse Okeson Fig. 5-18a

Optimal Force Magnitude

Summary

Anterior teeth cannot tolerate heavy forces on closure (due to axial inclination Posterior teeth are best able to withstand closing forces Anterior teeth are best able to tolerate eccentric forces

Laterotrusive Protrusive
Posterior bite collapse and heavy anterior forces Okeson Fig. 5-18a

Effect of Posture on Tooth Contacts

The postural position is maintained during periods of inactivity Lips are together and teeth are apart Usually there is a space of 2-4mm between the teeth Posture influences tooth contacts If occlusion is established with the patient reclined, a posteriorly positioned occlusion will be established With the patient upright, the mandible will be positioned slightly forward to this and result in heavy anterior contact Called the anterior envelope of function

Functional movements during a chewing stroke Okeson Fig. 419